الفهرس 
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Abstract
chronic Achilles tendon rupture can cause prolonged morbidity and disability unless treatment is appropriate. FHL tendon transfer is now considered the gold standard modality for the management of chronic ATR. Our study is designed to evaluate the role and results of FHL tendon transfer in chronic ATR through a single incision.
from April 2015 to June2016, fifteen patients with chronic ATR were treated by flexor halluces longus tendon transfer through a single incision in a prospective consecutive series. They were operated upon at the Trauma Unit and Department of Orthopaedics, Assiut University Hospitals.
The patients ranged in age from 16 to 70years and the mean age was 40.3 + 17.5years. There were eleven (73.3%) men and four (26.7%) women. chronic ATR occurred on the right side in 5 (33.3%) patients, on the left side in 10 (66.6%). As regarding the etiology, eight cases (53.3%) had degenerativeATR, while seven (46.7%) patients had traumatic etiology.
The operative time in our series ranged from 90 minutes to 135 minuteswith average operative time 105.3 +16.2 minutes.Titanium interference screws were used in 8 cases (53.3%), while bio-absorbable screws were used in 7 cases (46.7%).The size of the gap of Achilles tendon after debridment ranged from 4 – 9 cm with average 6.9 +1.7 cm. In our study, the pre-operative AOFAS score ranged from 28 to 66 with average score56.9 +8.6, AOFAS scoreat the final follow-upranged from 88 to 100 with average score94.3 +5.1 with maean AOFAS score difference 37.4 points which is a a statistically significant increase.Our study also revealed a statistaically significant correlation between the AOFAS score change and the etiology of theAchillses tendon rupture (AOFAS score improved more in trumatic patients compared to degenartive patients). It also revealed negative correlation between the AOFAS score change and both, age of the patient and size of the gap (AOFAS score improved more in younger patients and in patients with smaller gaps).
Complications secondary to the procedure included three cases (20.0%) who were complicated by superficial wound infection noticed during the second week post-operative follow up which had complete resolution later on by daily dressing through a small window in the cast just over the infected area and a good antibiotic coverage.
All the patients included in our study had no influence on the big toe function following the procedure. They all stated that they are satisfied about the surgery results and that they had better quality of life post-operatively compared to the pre-operative state.
There may be some limitations in our study:
A short follow up period was a drawback in our work. Longer follow-up is required to determine any further long term adverse effects. Small patient numbers and the lack of statistical analysis due to these numbers was another drawback. A larger series of cases may be beneficial.
This study demonstrated that direct transfer of FHL to the calcaneus through a single incision with interference screw fixation provides low morbidity and reliable outcomes for patients that have sustained chronic TA ruptures which was assessed by many factors mainly depending on the AOFAS score. The procedure facilitates a successful recovery of foot and ankle function, rapid return to pre-injury activity levels and improvement in patient quality of life..